Oesophageal webs refer to an oesophageal constriction caused by a thin mucosal membrane projecting into the lumen.
Oesophageal webs tend to affect middle-aged females.
Patients are usually asymptomatic and the finding may be incidental and unimportant. However, if the stenosis is severe symptoms include dysphagia and regurgitation of food.
More commonly occur in the cervical oesophagus near cricopharyngeus muscle than in the thoracic oesophagus. They typically arise from the anterior wall and never from the posterior wall; they can also be circumferential 4. Occasionally, multiple webs are visualised during maximal distension.
- Plummer-Vinson syndrome
- GORD/GERD (especially a distal oesophagus web) 7
- external beam radiation
Fluoroscopy: barium swallow
- may be demonstrated on high-volume barium oesophagrams when the oesophagus is fully distended 4
- a "jet effect" of contrast passing distal to the web may be seen 6
Treatment and prognosis
An oesophageal web may indicate an oesophageus at higher risk of upper oesophageal and hypopharyngeal carcinoma.
Treatment options include:
- balloon dilatation
- bougienage during endoscopy
- submucosal venous plexus: normal structure, noted anteriorly only as slightly irregular mucosa 5
- Schatzki ring: occurs in the distal oesophagus
- oesophageal dysmotility
- oesophageal tumours
- benign oesophageal neoplasms
- malignant oesophageal neoplasms
- gastro-oesophageal reflux disease
- oesophageal stricture
- 1. Karasick S, Lev-toaff AS. Esophageal strictures: findings on barium radiographs. AJR Am J Roentgenol. 1995;165 (3): 561-5. AJR Am J Roentgenol (abstract) - Pubmed citation
- 2. Rees CJ, Belafsky PC. Upper esophageal web. Ear Nose Throat J. 2007;86 (12): 732. - Pubmed citation
- 3. Kim KH, Kim MC, Jung GJ. Gastric cancer occurring in a patient with Plummer-Vinson syndrome: a case report. World J. Gastroenterol. 2005;11 (44): 7048-50. World J. Gastroenterol. (link) - Pubmed citation
- 4. Eisenberg RL. Gastrointestinal radiology. Lippincott Williams & Wilkins. (2003) ISBN:0781737060. Read it at Google Books - Find it at Amazon
- 5. Berry. Diagnostic Radiology. Jaypee Brothers Medical Publishers (P) Ltd. ISBN:8180612287. Read it at Google Books - Find it at Amazon
- 6. Taylor AJ, Stewart ET, Dodds WJ. The esophageal "jet" phenomenon revisited. AJR Am J Roentgenol. 1990;155 (2): 289-90. doi:10.2214/ajr.155.2.2115253 - Pubmed citation
- 7. Levine MS, Goldstein HM. Fixed transverse folds in the esophagus: a sign of reflux esophagitis. AJR Am J Roentgenol. 1984;143 (2): 275-8. doi:10.2214/ajr.143.2.275 - Pubmed citation